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The Case Identification Challenge in Measuring Quality of Cancer Care

From RAND Health and RAND Statistics Group, RAND, Santa Monica; University of California Los Angeles (UCLA) Schools of Medicine and Public Health, and Department of Medicine, UCLA Center for Health Sciences and Division of General Internal Medicine and Health Services Research, Los Angeles, CA; and Merck-Medco Managed Care, LLC, Franklin Lakes, NJ.

Address reprint requests to Katherine L. Kahn, MD, RAND, PO Box 2138, 1700 Main St, Santa Monica, CA 90407-2138; email: kkahn{at}rand.org

PURPOSE: The delivery of quality care to all patients with cancer has been named as a national priority within the American health care system. This article addresses the issues critical to case identification in cancer quality measurement and recommends possible strategies for accurately identifying a population of cancer patients.

METHODS: We present the measurement issues associated with the basic challenges of case identification strategies for quality measurement. We discuss two basic challenges: (1) accurately identifying all patients with the defining characteristics (eg, a diagnosis of breast cancer), and (2) identifying only patients with these characteristics.

RESULTS: Possible options for identifying newly diagnosed patients include using claims or other administrative data, cancer registries, cancer registry rapid case ascertainment, pathology laboratories, and physicians’ offices. In the published literature, the sensitivity of claims varies from 75% to 95%, whereas central registries must have a 90% completeness rate to be certified. Most of these approaches, however, involve limitations to obtaining valid and comparable data across multiple settings.

CONCLUSION: Using an existing data collection system staffed by skilled data collectors and managers should result in substantially more accurate and timely data. Registry officials and the government agencies that provide their support should be encouraged to adopt quality-of-care analyses as an important purpose of the registry system and to enhance their capacity to rapidly ascertain cases, collect the appropriate identifying information needed for patient contact, and verify stage at diagnosis. In order to meet the growing demand for timely, accurate information about quality of care, registries are likely to require additional support so they can enhance their capacity to rapidly ascertain cases, collect the appropriate identifying information needed for patient contact, and verify stage at diagnosis.

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